- Email: [email protected]
Sandifer's syndrome—A rare complication of hiatal hernia. A case report
98
ABSTRACTS
T h o r a c i c Air Gun Injuries in Children. D.S. Nakamura, J.J. McNamara, L. Sanderson, et al. Am J Surg 146:39~,2, (July), 1983.
Management of the Newborn with Gastrointestinal Anomalies and Tracheoesophageal Fistula. D.L. Mollitt and E.S.
Four boys aged 10 to 12 years were seen over a 5-year period with air gun injuries to the chest. Three involved the heart and one the lung. Two of the 3 cardiac injuries led to significant tamponade. The pulmonary injury did not lead to significant physiologic derangement or hemothorax, but the pellet was prophylactically removed to avoid embolization. In general, however, it is felt that pulmonary fragments may be observed. It is emphasized that cardiac injuries from air guns may be lethal. Thomas V. Whalen, Jr
Nine neonates with esophageal atresia (EA) and/or tracheoesophageal fistula [TEF] had 30 additional anomalies, 12 of which were in the GI tract. They were: malrotation (5), duodenal atresia (3), ileal atresia (1), Meckel's diverticulum (1), ectopic pancreas (1), and paraesophageal hernia (1). Five infants also had imperforate anus. All congenital intestinal obstructions were identified preoperatively. Four of 6 EA/TEF infants had simultaneous gastrostomy and additional abdominal procedures with extrapleural TEF ligation and esophagoesophagostomy. Two were staged. Two with isolated esophageal atresia had cervical esophagostomy at the time of laparotomy. Eight of the 9 infants survived. There was one death from postoperative cerebral hemorrhage in a patient with TEF, paraesophageal hernia, and Klippel-Feil Syndrome. It is the opinion of the authors that coexisting GI anomalies can be recognized preoperatively and corrected at one operative setting or in a planned, staged fashion.--Thomas V. Whalen, Jr
ALIMENTARY TRACT Results of Nissen's Operation Combined With Pyloroplasty and Surgical Indications in the Treatment of G.E.R. and Hiatus Hernia in Infants and Children. Report on 267 Cases.
C. Nihoul-Fekete, S. Lortat-Jacob, B. Jehannin, et al., Chirurgie 109:875-88 l, (December), 1983. Two hundred and sixty-seven Nissen operations are analysed over a 23-year period. One hundred and ninety-five were under 8 months of age at operation. One hundred and ninety-one had gastroesophageal reftux (GER) without esophagitis. Fifty-two had a peptic stenosis. Twenty-four were considered as secondary reflux after esophageal atresia, caustic ingestion, and subtotal resection of the small intestine. Recovery from GER occurred in 96.5% of cases. Mortality was 2.2%. Paraesophageal herniation or migration of the fundal wrap was observed in 12.6%. Reoperation was performed in these cases. It is postulated that a better gastropexy may avoid this complication. The pyloroplasty is done in order to avoid delayed gastric emptying. Indications for surgical treatment of GER include: hiatus hernia, persistent esophagitis after the age of six months, peptic stenosis associated with conservative management of the stenosis, acute pulmonary diseases without neurologic features, chronic pulmonary manifestations if pH monitoring, manometry, or scintiscans are "positive," and persistent G.E.R. after the age of two.--J.M. Guys Sandifer's Syndrome--A Rare Complication of Hiatal Hernia. A Case Report. A. Hadari, E. Azizi, O. Lernau, eta/. Z
Kinderchir 39:202-203, (June), 1984. A 13-year-old boy with Sandifer's syndrome is described whose symptoms disappeared following repair of a hiatus hernia by Nissen fundoplication. Sandifer's syndrome, first described in 1964, is a rare complication of hiatus hernia presenting with abnormal posture and movements of the head and neck. The peculiar movements are accompanied by a paradoxical movement of the diaphragm followed by elevation of the gastroesophageal junction with herniation. The association of abnormal head and neck movements are attributed to the common innervation of diaphragm and neck, and older children have claimed that the odd movements relieved them of the epigastric discomfort. This rare syndrome can be treated successfully by repair of the hiatus hernia and antireflux operation.--Thomas A. Angerpointner
Golladay. Am J Surg 146:792-795, (December), 1983.
Treatment of Esophageal Varices by Sclerotherapy in Children. J.B. Atkinson and M.M. Woolley. Am J Surg 146:103-
106, (July), 1983. During a 31/zyear period, 6 children with bleeding varices secondary to portal hypertension were treated by injection sclerotherapy using 3% sodium tetradecyl solution delivered through a rigid esophagoscope. Injection sites were limited to the distal third of the esophagus using no more than 3 mL of sclerosant. One of the 6 patients required a gastrostomy and oversewing of a gastric varix. All 6 patients had effective control of esophageal variceal bleeding as measured by decreased transfusion requirements after sclerosis. Follow-up is available for 10 to 36 months.--Thomas V. Whalen, Jr Sclerotherapy Continues To Undergo Evaluation. J. Korula.
JAMA 251:1 I33, (March 2), 1984. This news article reports a paper presented by Jacob Korula from the University of Southern California at a recent meeting. It is said to be the first prospective control study of chronic esophageal sclerotherapy from the United States. A comparison is made between treatment and control groups that had been randomized with 63 treated by sclerosants and 57 receiving standard medical therapy including blood transfusion, intravenous vasopressin, and esophageal tamponade. Although sclerotherapy decreases the number of bleeding episodes, the actual survival curves in the two groups are not significantly different.---David L. Collins The Role of Initial Cineesophagography in Caustic Esophageal Injury. J.R. Kuhn and W.P. Tunell. Am J Surg t 46:804-
806, (December), 1983. Sixty-eight patients with possible caustic esophagitis were evaluated from 1972 to 1982 by esophagoscopy, early cineesophagography, or both. Fourteen had endoscopically significant burns and 12 of these also had contrast examination.
ABSTRACTS
T h o r a c i c Air Gun Injuries in Children. D.S. Nakamura, J.J. McNamara, L. Sanderson, et al. Am J Surg 146:39~,2, (July), 1983.
Management of the Newborn with Gastrointestinal Anomalies and Tracheoesophageal Fistula. D.L. Mollitt and E.S.
Four boys aged 10 to 12 years were seen over a 5-year period with air gun injuries to the chest. Three involved the heart and one the lung. Two of the 3 cardiac injuries led to significant tamponade. The pulmonary injury did not lead to significant physiologic derangement or hemothorax, but the pellet was prophylactically removed to avoid embolization. In general, however, it is felt that pulmonary fragments may be observed. It is emphasized that cardiac injuries from air guns may be lethal. Thomas V. Whalen, Jr
Nine neonates with esophageal atresia (EA) and/or tracheoesophageal fistula [TEF] had 30 additional anomalies, 12 of which were in the GI tract. They were: malrotation (5), duodenal atresia (3), ileal atresia (1), Meckel's diverticulum (1), ectopic pancreas (1), and paraesophageal hernia (1). Five infants also had imperforate anus. All congenital intestinal obstructions were identified preoperatively. Four of 6 EA/TEF infants had simultaneous gastrostomy and additional abdominal procedures with extrapleural TEF ligation and esophagoesophagostomy. Two were staged. Two with isolated esophageal atresia had cervical esophagostomy at the time of laparotomy. Eight of the 9 infants survived. There was one death from postoperative cerebral hemorrhage in a patient with TEF, paraesophageal hernia, and Klippel-Feil Syndrome. It is the opinion of the authors that coexisting GI anomalies can be recognized preoperatively and corrected at one operative setting or in a planned, staged fashion.--Thomas V. Whalen, Jr
ALIMENTARY TRACT Results of Nissen's Operation Combined With Pyloroplasty and Surgical Indications in the Treatment of G.E.R. and Hiatus Hernia in Infants and Children. Report on 267 Cases.
C. Nihoul-Fekete, S. Lortat-Jacob, B. Jehannin, et al., Chirurgie 109:875-88 l, (December), 1983. Two hundred and sixty-seven Nissen operations are analysed over a 23-year period. One hundred and ninety-five were under 8 months of age at operation. One hundred and ninety-one had gastroesophageal reftux (GER) without esophagitis. Fifty-two had a peptic stenosis. Twenty-four were considered as secondary reflux after esophageal atresia, caustic ingestion, and subtotal resection of the small intestine. Recovery from GER occurred in 96.5% of cases. Mortality was 2.2%. Paraesophageal herniation or migration of the fundal wrap was observed in 12.6%. Reoperation was performed in these cases. It is postulated that a better gastropexy may avoid this complication. The pyloroplasty is done in order to avoid delayed gastric emptying. Indications for surgical treatment of GER include: hiatus hernia, persistent esophagitis after the age of six months, peptic stenosis associated with conservative management of the stenosis, acute pulmonary diseases without neurologic features, chronic pulmonary manifestations if pH monitoring, manometry, or scintiscans are "positive," and persistent G.E.R. after the age of two.--J.M. Guys Sandifer's Syndrome--A Rare Complication of Hiatal Hernia. A Case Report. A. Hadari, E. Azizi, O. Lernau, eta/. Z
Kinderchir 39:202-203, (June), 1984. A 13-year-old boy with Sandifer's syndrome is described whose symptoms disappeared following repair of a hiatus hernia by Nissen fundoplication. Sandifer's syndrome, first described in 1964, is a rare complication of hiatus hernia presenting with abnormal posture and movements of the head and neck. The peculiar movements are accompanied by a paradoxical movement of the diaphragm followed by elevation of the gastroesophageal junction with herniation. The association of abnormal head and neck movements are attributed to the common innervation of diaphragm and neck, and older children have claimed that the odd movements relieved them of the epigastric discomfort. This rare syndrome can be treated successfully by repair of the hiatus hernia and antireflux operation.--Thomas A. Angerpointner
Golladay. Am J Surg 146:792-795, (December), 1983.
Treatment of Esophageal Varices by Sclerotherapy in Children. J.B. Atkinson and M.M. Woolley. Am J Surg 146:103-
106, (July), 1983. During a 31/zyear period, 6 children with bleeding varices secondary to portal hypertension were treated by injection sclerotherapy using 3% sodium tetradecyl solution delivered through a rigid esophagoscope. Injection sites were limited to the distal third of the esophagus using no more than 3 mL of sclerosant. One of the 6 patients required a gastrostomy and oversewing of a gastric varix. All 6 patients had effective control of esophageal variceal bleeding as measured by decreased transfusion requirements after sclerosis. Follow-up is available for 10 to 36 months.--Thomas V. Whalen, Jr Sclerotherapy Continues To Undergo Evaluation. J. Korula.
JAMA 251:1 I33, (March 2), 1984. This news article reports a paper presented by Jacob Korula from the University of Southern California at a recent meeting. It is said to be the first prospective control study of chronic esophageal sclerotherapy from the United States. A comparison is made between treatment and control groups that had been randomized with 63 treated by sclerosants and 57 receiving standard medical therapy including blood transfusion, intravenous vasopressin, and esophageal tamponade. Although sclerotherapy decreases the number of bleeding episodes, the actual survival curves in the two groups are not significantly different.---David L. Collins The Role of Initial Cineesophagography in Caustic Esophageal Injury. J.R. Kuhn and W.P. Tunell. Am J Surg t 46:804-
806, (December), 1983. Sixty-eight patients with possible caustic esophagitis were evaluated from 1972 to 1982 by esophagoscopy, early cineesophagography, or both. Fourteen had endoscopically significant burns and 12 of these also had contrast examination.